Cerbera odollam: a 'suicide tree' and cause of death in the state of Kerala, India.

Cerbera odollam is a tree belonging to the poisonous Apocynaceae family, which includes the yellow and common oleanders. The seeds are excessively toxic, containing cerberin as the main active cardenolide. Cerbera venenifera, a related species found in Madagascar, has a long history as an ordeal poison, and was responsible for the death of 3000 people per year in previous centuries. The odollam tree is responsible for about 50% of the plant poisoning cases and 10% of the total poisoning cases in Kerala, India. It is used both for suicide and homicide. The aim of this retrospective study is to call attention to a powerful toxic plant that is currently completely ignored by western physicians, chemists, analysts and even coroners and forensic toxicologists.